腰硬联合麻醉用于新式剖宫产术180例

The Clinical Observations of 180 Cases with New Cesarean Section by Spinal Anesthesia

目的探讨腰、硬联合麻醉在新式剖宫产术的临床效果。方法选取我院经阴试产失败或选择性剖宫产而无腰麻禁忌的孕妇360例,随机分为对照组和观察组,各180例。其中对照组孕妇采用单纯硬膜外麻醉;观察组孕妇采用腰麻,必要时追加硬膜外麻醉。比较两组麻醉诱导时间、镇痛效果、肌肉松弛效果、对全身生理影响、麻醉药物用量、有效阻滞时间、产后子宫收缩及出血,对胎儿的影响及不良反应发生率等。结果观察组孕妇麻醉起效时间短,镇痛效果、肌肉松弛、利于手术操作、缩短手术时间、新生儿窒息明显优于对照组,组间比较差异显著(P<0.05),患者麻醉药物用量及诱导时间明显高于对照组,组间比较差异显著(P<0.05);观察组产后出血、麻醉不良反应、手术后胃肠功能恢复等优于对照组,有显著差异(P<0.05)。结论观察组效果明显优于对照组,值得推广应用。

Objective To explore the clinic effect of spinal-epidural anesthesia to new cesarean section. Methods 360 patients with surgical indications of cesarean section were selected from 2012.3 to 2013.1 in our hospital. They were randomly divided into the control group and the observation group, each group with 180 cases. Pregnant women in the con- trol group were treated by epidural anesthesia. The observation group were treated by spinal anesthesia, epidural catheter, if necessary, additional by epidural anesthesia. The excellent rate of analgesia and muscle relaxation, the changes in vital signs before and after anesthesia, the dosage of narcotic drugs, effective blockade time, postpartum uterine contractions and bleeding, fetal effects and the rate of adverse reaction were compared between two groups. Results The analgesic effect, muscle relaxation, conducive to the surgical procedure, shorten the operation time in the observation group were obviously better than those in the control group, and the comparison between groups was significantly different （P〈0.05）. The dosage of narcotic drugs, effective blockade time in the observation group were obviously better than those in the control group, and the comparison between groups was significantly different （P〈0.05）. Postpartum hemorrhage, neonatal asphyxia, post- operative recovery of gastrointestinal function in the observation group were better than those in the control group, with sig- nificant difference （P〈0.05）. Conclusion New cesarean section by spinal-epidural anesthesia shows no impact on fetus, but could effectively improve the effect of muscle relaxation and analgesia, shorten the operation time, be conducive to the surgical procedure, shows significant effects.